Antivirals cut liver cancer risk in Hep C patients
Medicines recently added to Australia’s Pharmaceutical Benefits Scheme for treating hepatitis C, known as direct-acting antivirals, have been found to be associated with a reduced risk of liver cancer and death in people with chronic hepatitis C.
Published in The Lancet, the research is the first to demonstrate the clinical effectiveness of direct-acting antivirals on the disease and suggests that they should be considered for all patients with chronic Hep C.
Around the world, an estimated 71 million people are chronically infected with the hepatitis C virus (HCV). The infection causes complications such as cirrhosis, liver disease and hepatocellular carcinoma, and many people die as a result. Over the last 15 years, these complications have tripled and models predict they will peak between 2030 and 2035.
The aim of direct-acting antiviral drugs is to achieve a sustained virological response, meaning that the virus is undetectable in the blood of the patients. Previous work has shown there is a reduction of risk for complications and mortality in patients who are treated with direct-acting antivirals, but few studies have compared treated and untreated patients.
The new research, led by the University of Melbourne and France’s Sorbonne Université, was an observational study that followed 10,166 patients Hep C patients, recruited from 32 centres in France, over two years. At a median of 33 months, 9895 patients had available follow-up information and were included in the analysis, with 7344 treated with direct-acting antivirals and 2551 untreated. During follow-up, 218 patients died (129 treated, 89 untreated), 258 reported hepatocellular carcinoma, the most common form of liver cancer (187 treated, 71 untreated), and 106 had decompensated cirrhosis (74 treated, 32 untreated).
The researchers initially found an increase in risk associated with treatment with direct-acting antiviral treatment, but the outcome changed once they had adjusted for variables such as age, sex, BMI, severity of liver disease, geographical origin, infection route and other factors. Patients who were treated were 52% less likely to die prematurely than people who were not treated, and 33% less likely to present with hepatocellular carcinoma.
In a subgroup of 3045 patients with cirrhosis at baseline, the same association was found for mortality and hepatocellular cancer, provided the patients achieved an undetectable level of HCV in their blood. The researchers believe this is because the treatment induces a sustained virological response, allowing the liver to regenerate.
Overall, the study found that direct-acting antiviral treatment is associated with reduced risk for global mortality and hepatocellular cancer, but not decompensation of cirrhosis.
“Taking a large cohort like this provides the opportunity to evaluate the effect of direct-acting antiviral therapy on the long-term outcomes of patients with hepatitis C,” said Professor Fabrice Carrat of the Sorbonne Université. “We saw a reduction of risk for complications related to the disease, and to mortality, and believe this treatment should be considered for all patients with chronic hepatitis C infection.”
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